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End-of-life care

Created date

October 22nd, 2014

One of the greatest advances in medicine over the past thirty years has been in the care of progressive and terminal illness. These improvements have occurred largely because health care providers have come to learn the importance of listening and honoring patients’ needs and preferences. Fortunately, we have moved to a patient-centered approach and a dialogue where both treating illness and addressing quality of life can occur simultaneously. This approach is fundamental to both hospice and palliative care services, which have grown dramatically and now serve over one million seniors annually.

Hospice, which has been a Medicare entitlement since 1983, is not only for people with terminal cancer. Anyone with an end-stage illness such as severe disease of the heart, lungs, or kidneys can qualify for benefits. More recently, the use of hospice services has been growing rapidly among individuals with Alzheimer’s and other dementia-related illnesses. It is important to note that the Medicare hospice benefit is only available if a physician certifies that death is likely to occur within six months’ time.

Hospice services are intended to provide comfort and support to the patient, family, and caregivers in realizing a death with dignity and without suffering—ideally at home or in a homelike setting. The services are designed to address concerns in all areas of emotional and physical health. The coordinated hospice team may include doctors; nurses; social workers; spiritual advisors; financial specialists; bereavement specialists; personal care aides; and physical, occupational, and speech therapists. 

Palliative care has become a recognized medical specialty and includes care of the terminally ill as well as individuals with advanced illness. The goals of palliative care are to manage symptoms, improve quality of life, maximize daily functioning, and ease the emotional stress of being seriously ill. Research has shown these programs are effective and often result in substantial improvements in health and well-being. Remarkably, patients in palliative care may live longer than those receiving standard care for the same condition. It makes sense when you consider that palliative care treats your needs and preferences while you go through what is often aggressive medical care, such as chemotherapy.

Careful consideration

The decision to enroll in hospice care is never easy and should be made in close communication with family, friends, and the medical providers who know you best. Hospice is a wonderful benefit, but like all medical care, it should only be used when appropriate. Recently, hospice has been in the news because a few companies are allegedly enrolling patients prematurely and profiting from treating Medicare beneficiaries who are not necessarily terminally ill. While this appears to be rare, you can always check in with Medicare, your state’s attorney’s office, the Office of the Inspector General, or your local Senior Medicare Patrol (SMP) if you have concerns. 

Hospice and palliative care services can be of enormous benefit as you and your family approach decisions about how to provide comfort and care through advanced illness or toward the end of life.